Universal versus selective gestational diabetes screening: Application of 1997 American Diabetes Association recommendations

Danilenko-Dixon, Diana R.; Winter, Jo T. Van; Nelson, Roger; Ogburn, Paul L.

doi:10.1016/s0002-9378(99)70304-2

Cited by 155 publications

(72 citation statements)

References 8 publications

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“…This same order of importance is documented in other studies (23,30,31,34,35). Yet it is noteworthy that our survey identified the antecedent of GDM itself in only 0.8% of the women, a frequency much lower than that reported in other series (30,35).…”

Section: Discussionsupporting

confidence: 87%

Prevalence of gestational diabetes mellitus: variations related to screening strategy used

Jiménez-Moleón

Bueno‐Cavanillas

Luna-del-Castillo

et al. 2002

European Journal of Endocrinology

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Objective: To determine the prevalence of gestational diabetes mellitus in a large general obstetric population and its variations depending on the presence of risk factors, and to evaluate how the gestational diabetes screening strategies applied might modify the observed prevalence in the population. Design: A retrospective cohort study. Methods: The study population was a total of 2574 pregnant women. Information about risk factors, screening and diagnosis of gestational diabetes was obtained. Frequency of risk factors under the American College of Obstetrics and Gynecologists (ACOG) and the American Diabetes Association (ADA) criteria, and observed and expected prevalence of gestational diabetes mellitus were calculated and compared for statistical significance. Results: Age $ 30 years, family history of diabetes, obesity and previous fetal macrosomia were the most frequent risk factors. Under ACOG recommendations, 45% of our general obstetric population would have been exempt from gestational diabetes mellitus screening, as compared with only 15.5% under ADA guidelines. Sixty-five patients were diagnosed as having gestational diabetes mellitus, giving an overall prevalence of 2.5% (confidence interval 2.0 -3.2). Among the low-risk women, prevalence values were 0.6% and 0.5% respectively under ACOG and ADA criteria, whereas for those presenting one or more risk factors rates were 4% and 2.9% respectively. Conclusions: In our general obstetric population, gestational diabetes mellitus prevalence was found to be approximately six times lower among low-risk gravidae than among the high-risk subjects, suggesting that selective screening might be beneficial. Nevertheless, selective gestational diabetes mellitus screening under ADA criteria seems to entail the same disadvantages as the selective screening strategies without any apparent benefits.

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Section: Discussionsupporting

confidence: 87%

Prevalence of gestational diabetes mellitus: variations related to screening strategy used

Jiménez-Moleón

Bueno‐Cavanillas

Luna-del-Castillo

et al. 2002

European Journal of Endocrinology

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“…[4] While it is well known that women with GDM have certain definable risk factors, there is concern that a significant proportion of women with GDM will be missed if screened by risk factors alone, as has been illustrated in numerous studies. [5][6][7] Current international opinion favours the universal screening of all pregnant women for GDM, where local circumstances allow.…”

Section: Researchmentioning

confidence: 99%

Screening for gestational diabetes mellitus in a South African population: Prevalence, comparison of diagnostic criteria and the role of risk factors

2017

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Background. The prevalence of gestational diabetes mellitus (GDM) is increasing. Most major world organisations now recommend universal screening for GDM based on the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria. Currently there is a lack of consensus on the diagnostic criteria for GDM used in South Africa (SA). The Society for Endocrinology, Metabolism and Diabetes of South Africa's revised guidelines recommend the use of the IADPSG criteria for the diagnosis of GDM. Objectives. To determine the prevalence of GDM in an SA population. We compared the prevalence of GDM using the various diagnostic criteria and evaluated the risk factors associated with GDM. Methods. This was a prospective cohort observational study carried out at a level 1 clinic in Johannesburg, SA. All pregnant women at <26 weeks' gestation were recruited. Patients known to have GDM were excluded. At recruitment, a data questionnaire was completed and bloods were drawn for a random glucose test and measurement of the glycated haemoglobin level. A 75 g 2-hour oral glucose tolerance test (OGTT) was scheduled before 28 weeks' gestation. Results. Five hundred and fifty-four patients (55.4%) completed the OGTT. The prevalence of GDM was 25.8% if universal screening and the IADPSG criteria were used. If universal screening and the National Institute for Health and Care Excellence (NICE) criteria were used, the prevalence was 17.0%. If selective risk factor-based screening was used, only 254 (45.8%) of the women would have had an OGTT. The prevalence of GDM in this instance would have been 15.2% with the IADPSG criteria and 3.6% with the NICE criteria. Two hundred and fifty-four patients (45.8%) had at least one risk factor for GDM. The presence of one or more risk factors had a poor sensitivity (58.7%) and specificity (58.6%) for the detection of GDM in our study population. Conclusions. The prevalence of GDM would be substantially increased if universal screening with the IADPSG criteria were to be employed. Risk factors are a poor screening test for GDM.

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“…The hospital-based studies conducted in the United States diagnosed GDM based on a 3-hour OGTT and report prevalence rates ranging from 2.7% using the NDDG criteria to 6.8% in a largely Mexican American population using the C & C criteria (89)(90)(91). In a Canadian study at the Saskatoon Royal University Hospital, using the NDDG criteria, the prevalence was 11.5% in the Aboriginal population and 3.5% in the non-Aboriginal population (92).…”

Section: Hospital-based Studiesmentioning

confidence: 99%

The Increasing Prevalence of Diabetes in Pregnancy

Hunt

Schuller

2007

Obstetrics and Gynecology Clinics of North America

420

272

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Universal versus selective gestational diabetes screening: Application of 1997 American Diabetes Association recommendations

Cited by 155 publications

References 8 publications

Prevalence of gestational diabetes mellitus: variations related to screening strategy used

Prevalence of gestational diabetes mellitus: variations related to screening strategy used

Screening for gestational diabetes mellitus in a South African population: Prevalence, comparison of diagnostic criteria and the role of risk factors

The Increasing Prevalence of Diabetes in Pregnancy

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